Less autonomous specialties

[Annabananna]

Hi all, 

I am currently a working PA in family med on the job market again. This has been my first job and i manage a clinic by myself. I have learned I really would prefer working under a doc and managing the same patients if possible. 

Besides surgery, what are the least autonomous specialties? I would appreicated any input! 

[LT_Oneal_PAC]

Oncology

and this may be the strangest question I’ve ever seen on the forum

[Boatswain2PA]

11 minutes ago, LT_Oneal_PAC said:

Oncology

and this may be the strangest question I’ve ever seen on the forum

Lots of PAs dont agree with the movement for independence.

[MediMike]

Anna I feel like you've brought this question up in prior threads as well? Maybe I'm wrong. But there was good advice in those threads. Academic anything. Surgery. Certain EDs. Heme/Onc. Cardiology? Honestly it more depends on the practice setting than the specialty.

[LT_Oneal_PAC]

36 minutes ago, Boatswain2PA said:

Lots of PAs dont agree with the movement for independence.

That’s got nothing to do with why I think it’s strange. I think it’s fine for people wanting less responsibility. What I think is strange is someone wanting the the LEAST autonomy. More peculiar is it is regardless of specialty, setting, work environment other than to say they don’t want to be in surgery. Most people who become a PA want to have some responsibility, even at a low level. I mean, if you don’t, why not just do something else that pays as well or better with responsibility.

[Annabananna]

57 minutes ago, LT_Oneal_PAC said:

That’s got nothing to do with why I think it’s strange. I think it’s fine for people wanting less responsibility. What I think is strange is someone wanting the the LEAST autonomy. More peculiar is it is regardless of specialty, setting, work environment other than to say they don’t want to be in surgery. Most people who become a PA want to have some responsibility, even at a low level. I mean, if you don’t, why not just do something else that pays as well or better with responsibility.

I think it’s difficult sometimes as a new grad to understand the level of responsibility that you have to have a as a PA. I guess I should specify that I would like more of a collaborative environment. But what you’re telling me about a new profession has definitely crossed my mind. 

Edited September 6, 2020 by Annabananna

[Boatswain2PA]

10 hours ago, LT_Oneal_PAC said:

What I think is strange is someone wanting the the LEAST autonomy. More peculiar is it is regardless of specialty, setting, work environment other than to say they don’t want to be in surgery.

Gotchya.

At the risk of being called mysogenistic/etcetera (and making a statistical inference about the OP), our profession is going in two opposite directions at once.  There is a growing movement toward autonomy, yet we are moving further toward being a profession of very young women with no real life experience who has just 2 years of medical education. 

[TheFatMan]

On 9/6/2020 at 8:51 AM, Boatswain2PA said:

Gotchya.

At the risk of being called mysogenistic/etcetera (and making a statistical inference about the OP), our profession is going in two opposite directions at once.  There is a growing movement toward autonomy, yet we are moving further toward being a profession of very young women with no real life experience who has just 2 years of medical education. 

Schools recruiting high GPAs without any quality health care experience. 

 

EDIT: this applies to both male and female. 

Edited September 7, 2020 by TheFatMan

[Hope2PA]

Few points, The two year education is always so misleading. Physicians have four years, however when you count time actually taking classes, it can and is being done in three. So one would assume PA is about 2/3rd of physicians. Physicians are typically required 3 year residency. Some good, some appear to be little more than what a PA would get with a decent physician supervisor. Giving a new PA independence would be idiotic. Giving a PA with 5 years independence is smart professional move. Nurses with no Medical experience Are going straight into NP programs with less than half the education and training as PA’s, yet they have gained independence in a year to 3 years experience. PA’s need to protect their future or you will Eventually be working on par with RN and in many places less salary. Gain independence With rules or guidelines for graduated/staged  to protect patient (better than nursing is currently doing),

you are not protecting patients by standing by taking the higher ground and losing out on jobs.

[turnedintoamartian]

1 hour ago, Boatswain2PA said:

Gotchya.

At the risk of being called mysogenistic/etcetera (and making a statistical inference about the OP), our profession is going in two opposite directions at once.  There is a growing movement toward autonomy, yet we are moving further toward being a profession of very young women with no real life experience who has just 2 years of medical education. 

I do not disagree with this summation with the caveat that I am hoping you will specify what young females vs young males is implying. 
 

I believe physicians are nearing 50/50 distribution for M:F.

Thanks in advance.

[ANESMCR]

20 hours ago, Annabananna said:

Hi all, 

I am currently a working PA in family med on the job market again. This has been my first job and i manage a clinic by myself. I have learned I really would prefer working under a doc and managing the same patients if possible. 

Besides surgery, what are the least autonomous specialties? I would appreicated any input! 

You may desire this secondary to the new grad discomfort you’ve experienced. But I suspect you will highly regret pursuing this once it reaches fruition. 

[Annabananna]

1 hour ago, ANESMCR said:

You may desire this secondary to the new grad discomfort you’ve experienced. But I suspect you will highly regret pursuing this once it reaches fruition. 

Regret pursuing less autonomy? Thanks for the input! 

[rev ronin]

8 hours ago, turnedintoamartian said:

I do not disagree with this summation with the caveat that I am hoping you will specify what young females vs young males is implying.

Females have more babies than males.

Females take more sick leave than males, often to care for their kids or parents rather than just themselves.

Females are less likely to settle for a ridiculous work-life imbalance than males.

If I'm a practice, I want someone who has horrible work-life balance, derives their sense of self from their job, never takes leave, and treats their families as an afterthought.  Not many women fit that bill.

[EMEDPA]

40 minutes ago, rev ronin said:

If I'm a practice, I want someone who has horrible work-life balance, derives their sense of self from their job, never takes leave, and treats their families as an afterthought. 

Sounds like I am your man...:(

[ohiovolffemtp]

@turnedintoamartian

I believe Boat's comments are based on the demographics of most PA school cohorts: typically 2/3-3/4 female and usually < 25 years old.   Boats - please correct me if I misunderstood or if anything else should be implied.  

Based on the data I could find,  specifically quotes from NCCPA stats, just under 75% of PA's are female.  That matches my PA school cohort which was 75% female.  Data I could find indicates that females medical students slightly outnumber males.

[turnedintoamartian]

11 hours ago, rev ronin said:

Females have more babies than males.

Females take more sick leave than males, often to care for their kids or parents rather than just themselves.

Females are less likely to settle for a ridiculous work-life imbalance than males.

If I'm a practice, I want someone who has horrible work-life balance, derives their sense of self from their job, never takes leave, and treats their families as an afterthought.  Not many women fit that bill.

I was asking what being a young female with minimal clinical experience compared to a young male with minimal clinical experience might have to do with the push for more autonomy.

You are highlighting men generally work more hours than women and that this is preferred by an employer. I don’t disagree. 
 

[BayPAC]

Go to SURGERY. The least autonomous specialty if any autonomy at all. 

[CornellSPA]

1 hour ago, BayPAC said:

Go to SURGERY. The least autonomous specialty if any autonomy at all. 

I've found in surgery I have a great deal of autonomy:

-Seeing consults in the ED and booking them- surgeon meets the patient in Pre-op 

-Running the pre & post-op clinic while the surgeon is home or in the hospital

-Post-op telemedicine, wound checks etc etc. 

-Deciding how to close up a midline laparotomy while the surgeon starts a case in the other room 

 

etc! 

[BayPAC]

1 hour ago, CornellSPA said:

I've found in surgery I have a great deal of autonomy:

-Seeing consults in the ED and booking them- surgeon meets the patient in Pre-op 

-Running the pre & post-op clinic while the surgeon is home or in the hospital

-Post-op telemedicine, wound checks etc etc. 

-Deciding how to close up a midline laparotomy while the surgeon starts a case in the other room 

 

etc! 

I guess this changes from organization to organization. The PA where I did my surgery rotation only performed first assist duties. 

[ANESMCR]

19 hours ago, Annabananna said:

Regret pursuing less autonomy? Thanks for the input! 

Yes. My point being that as you become a more efficient and experienced provider, you will absolutely not enjoy “sharing” every patient care encounter a supervising provider. But if that’s what you want I’d agree with LT, go into oncology. 

[Boatswain2PA]

On 9/6/2020 at 10:25 AM, Hope2PA said:

The two year education is always so misleading. Physicians have four years, however when you count time actually taking classes, it can and is being done in three. So one would assume PA is about 2/3rd of physicians. Physicians are typically required 3 year residency. Some good, some appear to be little more than what a PA would get with a decent physician supervisor. Giving a new PA independence would be idiotic. Giving a PA with 5 years independence is smart professional move.

You are minimizing the importance of the residency where the purpose of that doc practicing supervised is to LEARN, unlike a new PA whose job is to see patients.  And only a few specialties have 3 year residencies, most have more, plus fellowships.  There is a HUGE gap between physician education and PA education.

 

On 9/6/2020 at 10:39 AM, turnedintoamartian said:

hoping you will specify what young females vs young males is implying. 

Nope.  Not gonna go into that minefield.  

Our society used to understand that men were men and women were women.  Each sex (back when there WERE only two sexes) had their generalized strengths and weaknesses that were generally complimentary to each other.

In todays society it is dangerous to voice any opinion that is not of the politically correct variety.

[SedRate]

4 hours ago, CornellSPA said:

I've found in surgery I have a great deal of autonomy:

-Seeing consults in the ED and booking them- surgeon meets the patient in Pre-op 

-Running the pre & post-op clinic while the surgeon is home or in the hospital

-Post-op telemedicine, wound checks etc etc. 

-Deciding how to close up a midline laparotomy while the surgeon starts a case in the other room 

 

etc! 

Same here for trauma and acute care surgery. We consult, run the traumas and carry both the floor and ICU pager. We manage vents and drips, assist, do procedures, and run clinic. Some surgeons like to be more involved while others are more hands-off. 

And likewise for the most part at the Ortho trauma practice I was previously at. But then the structure changed and I was then mainly just assisting and post-op rounding. No thanks.

[turnedintoamartian]

8 hours ago, Boatswain2PA said:

You are minimizing the importance of the residency where the purpose of that doc practicing supervised is to LEARN, unlike a new PA whose job is to see patients.  And only a few specialties have 3 year residencies, most have more, plus fellowships.  There is a HUGE gap between physician education and PA education.

 

Nope.  Not gonna go into that minefield.  

Our society used to understand that men were men and women were women.  Each sex (back when there WERE only two sexes) had their generalized strengths and weaknesses that were generally complimentary to each other.

In todays society it is dangerous to voice any opinion that is not of the politically correct variety.

I agree regarding the difference between residency and our role in patient care. We see patients and preferably at maximum capacity, residents have structured learning.

Female vs male: it seemed like you said female for a reason but now you won’t clarify. I do understand why but I don’t know if it’s worth making that statement the begin with.

It might be generational as well. Boomer physicians work more than millennials. Perhaps the push for more autonomy is split more along generational lines?

[MediMike]

11 hours ago, Boatswain2PA said:

Nope.  Not gonna go into that minefield.  

Our society used to understand that men were men and women were women.  Each sex (back when there WERE only two sexes) had their generalized strengths and weaknesses that were generally complimentary to each other.

In todays society it is dangerous to voice any opinion that is not of the politically correct variety.

Sometimes it's like you are a time traveler from the 50s.

Generalizing is no different than stereotyping. I know innumerable women who are top of their class paramedic/firefighters without these supposed generalized weaknesses or strengths that you are insinuating. I've had the opportunity to work with ridiculously strong women and incredibly weak men. Men who want to be stay at home father's while their wives work and vice versa. Women who lack assertiveness and women who put me in my place. Probably more men who get walked over than anything else.

Sorry man. The time to generalize is over. Anybody can be anything these days

[Boatswain2PA]

8 hours ago, MediMike said:

Sometimes it's like you are a time traveler from the 50s.

Generalizing is no different than stereotyping.

And yet, you just generalized/stereotyped people from the 50s.

I never inferred that women were incapable of anything.  Twenty years in the military as an operator, including two tours in command of units that included women and people of every skin color, has given me the experience to see women excel across the board.

Men and women have differences.  Some of these are absolute (well, they used to be considered absolute) like birthing and lactating.  Others are more general to the sex, but are not absolute.  The easiest example of this is that men are generally physically stronger than women.  As with all generalizations, this is not absolute as there are many women who have greater physical strength than some men.  

Regarding this topic, my point was that (generally) young men are greater risk-takers than young women.  I think working autonomously at the beginning of a career with just 2 years of medical training can reasonably be considered high risk, especially if you don't have a wealth of life-experiences to draw on as well.  

And before someone starts shooting arrows my way for declaring that young women are not risk takers----my point is well established in the psych literature, and is accepted in society by things like insurance rates.  It also does NOT mean that women are in any way inferior to men.  Personal example:  When training my crews, I would usually have to push the young men to take LESS risk, while pushing the young women to take GREATER risk to get the mission accomplished.   This led me to sleep better when I had a woman leading the ready crew!

 

11 hours ago, turnedintoamartian said:

It might be generational as well. Boomer physicians work more than millennials.

Oh look, another generalization. 

 

 

 

Edited September 8, 2020 by Boatswain2PA